Trauma Informed Care

October 4th, 2021

Dr. Diane Smith
Assistant Professor
Teri Tench
Assistant Professor
 Disclosure Statement
• Approval statement: Continuing Nursing
Education Contact Hours are being provided by
the Bon Secours Mercy Health. Bon
Secours Mercy Health is approved with
distinction as a provider
of nursing continuing professional development b
y the Virginia Nurses Association, an accredited
approver by the American Nurses Credentialing
Center's Commission on Accreditation. 
 Trauma Informed Care Objectives
 Identify the causes of Trauma
 Define Trauma Informed Care
 Discuss the Six Guiding Principles of Trauma Informed care
 Describe the Key Components of Trauma Informed Care
 Apply how You as an Educator can Prepare Future Nurses for Practice Using a
Trauma Inform Care Philosophy

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 Part 1:
What is Trauma?
Trauma
• Trauma occurs when a person is overwhelmed
by events or circumstances and responds with
intense fear, horror, and helplessness.
• Extreme stress overwhelms the person’s
capacity to cope.
 Causes of Trauma

Trauma can stem from

 Childhood abuse or neglect
 War and other forms of violence
 Physical, emotional, or sexual abuse
 Accidents and natural disasters
 Grief and loss
 Witnessing acts of violence
 Cultural, intergenerational and historical trauma
 Medical interventions
 Symptoms of Trauma

 Headaches, backaches, stomachaches, etc.

 Sudden sweating and/or heart palpitations
 Changes in sleep patterns, appetite, interest in sex
 Constipation or diarrhea
 Easily startled by noises or unexpected touch
 More susceptible to colds and illnesses
 Increased use of alcohol or drugs and/or overeating
 Fear, depression, anxiety
 Outbursts of anger or rage
 Symptoms of Trauma

 Emotional swings
 Nightmares and flashbacks — re-experiencing
the trauma
 Tendency to isolate oneself or feelings of
detachment
 Difficulty trusting and/or feelings of betrayal
 Self-blame, survivor guilt, or shame
 Diminished interest in everyday activities
 Childhood/Teen Trauma
Adverse Childhood Experience(ACE)Questioner
10 types of childhood or teen trauma that
occurred before age 18
 Abuse
 Neglect
 Household dysfunction
 Exciting News!

People can and do

recover from trauma!!!
 Trauma Informed Care
Trauma Informed Care is an organizational
structure and treatment framework that involves
understanding, recognizing, and responding to
the effects of all types of trauma. Trauma
Informed Care also emphasizes physical,
psychological and emotional safety for both
consumers and providers, and helps survivors
rebuild a sense of control and empowerment.
 Trauma Informed Care

Healthcare providers must change their approach

What is wrong with you????

VS.
What happened to you??????
 Trauma Informed Care
• Realizes the widespread impact of trauma and
various paths for recovery.
• Recognizes the signs and symptoms of trauma
in clients, families, staff, and all those
involved within the system.
• Responds by fully integrating knowledge
about trauma in policies, procedures, and
practices.
• Seeks to actively resist traumatization.
 Trauma Informed Care
Principles of TIC
1. Safety
2. Trustworthiness and Transparency
3. Peer Support
4. Collaboration and Mutuality
5. Empowerment
6. Cultural, Historical and Gender Issues
 Trauma Informed Care
Interventions
 Respect the Client
 Collaborate and Connect
 Provide information about the impact trauma
has on health and wellbeing
 Teach coping mechanisms
 Instill Hope
 Empower the trauma survivor to guide and
direct their recovery plan(patient centered care)
 Trauma Informed Care
Therapies
 CBT
 Eye Movement Desensitization and
Reprocessing (EMDR) therapy
 Group Therapy
 Exposure Therapy
 Massage Therapy
 Trauma Recovery Support Groups
 Trauma Informed Education
Preparing Students to Practice using a Trauma
Informed Care Approach
 Provide a safe learning environment
 Educate students about Secondary Trauma
 Develop course specific objectives that include
learning opportunities for TIC enhancement
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 Part 2:
Measuring Our Ability to Care
Using
the Professional Quality of Life Questionnaire
 Vocabulary
• Compassion Satisfaction
– Positive aspects of working as a helper
• Compassion Fatigue
– Negative aspects of working as a helper
• Burnout
– Inefficacy and feeling overwhelmed
• Work-related traumatic stress
– Primary traumatic stress direct target of event
– Secondary traumatic exposure to event due to a
relationship with the primary person
 Professional Quality of Life
Compassion Satisfaction Compassion Fatigue
• The positive aspects • The negative aspects of
of helping helping
• “The good stuff” • “The bad stuff’
 CS-CF Model

Professional Quality of Life

Compassion Compassion
Satisfaction Fatigue

Secondary
Burnout
Trauma
 Compassion Satisfaction
• The positive aspects of helping
– Pleasure and satisfaction derived from working in
helping, care giving systems
• May be related to
– Providing care
– To the system
– Work with colleagues
– Beliefs about self
– Altruism
 Compassion Fatigue
• The negative aspects of helping
• The negative aspects of working in helping
systems may be related to
– Providing care
– To the system
– Work with colleagues
– Beliefs about self
• Burnout
• Work-related trauma
 Burnout and STS: Co Travelers
• Burnout
– Work-related hopelessness and
feelings of inefficacy
• STS
– Work-related secondary
exposure to extremely or
traumatically stressful events
• Both share negative affect
– Burnout is about being worn
out
– STS is about being afraid
© Beth Hudnall Stamm, 2009. Professional Quality of Life Scale (ProQOL).
www.proqol.org. This test may be freely copied as long as (a) author is credited,
(b) no changes are made without author authorization, and (c) it is not sold.
 Relationships Are Complex
• Multiple spheres
– Work environment
– “People helped” environment
– Personal environment
• Positive (CS) & negative (CF)
• Altruism CS can override CF
• Compassion Fatigue two parts
– Worn out (BO) common
– Frightened, traumatized (STS)
rarer but powerful
 Complex Relationships
Work
Environment Compassion
Satisfaction
(ProQOL CS)

Exhaustion Depressed by
Professional Client Compassion Work
Quality Environment Fatigue Environment
of Life Frustration (ProQOL Burnout)
Anger

Secondary
Exposure
(ProQOL STS)
Personal Traumatized
Environment by work

Primary
Exposure
 People Bring Themselves
• People bring a past and a present to anything they
do
– Their schemas and beliefs
– Their stigma beliefs
– Their social support systems
• Positive support
• Negative support
– Their history of trauma and illness
– Their families and close others
– Their economic situation
 Resiliency Planning
• Individual, personally
– The ProQOL can help you plan where to put your
energy to increase our resilience

Perseverance, no matter what the odds

For More Information:

WWW.PROQOL.ORG
QUESTIONNAIRE:
HTTPS://PROQOL.ORG/UPLOADS/PROQOL_5_ENGLISH_SELF-SCORE_3-2012.PDF
Measuring CS & CF: The Professional Quality
of Life Scale (ProQOL)
• The ProQOL questionnaire is free
• A 30 item self report measure of the positive
and negative aspects of caring
• The ProQOL measures Compassion
Satisfaction and Compassion Fatigue
• Compassion Fatigue has two subscales
– Burnout
– Secondary Trauma
 Well Established
• The ProQOL is the most widely used measure
of the positive and negative aspects of helping
in the world
• The ProQOL has proven to be a valid measure
of compassion satisfaction and fatigue
• It has been used for over 15 years
• The measure was developed with data from
over 3000 people
 Not a Medical Test
• Helps understand the positive and negative
aspects of helping
• Not a “psychological test”
• Not a “medical test”
• Can be viewed as a screening for stress-
related health problems
 Interpreting Scores
• Scores on individual scales tell us about a
person’s responses on each of the questions
• Viewing the combination of scores helps us
“paint a picture” of what the person is telling
us
• Can be used to track an individual’s
Compassionate Satisfaction and Compassion
Fatigue
 Easy to Score
• The ProQOL is easy to use
• You will take the questionnaire by accessing it on the link
provided.
• You will click on the link, download the questionnaire and
then print it out.
• Complete the paper ProQOL Questionnaire
• Scoring
– Can be completed quickly and can be intuitively
understood
– Good for learning
 Break Out Session
1. Were you surprised with the scores?
2. With the scores in front of you, were the
scores reflective of where you are
professionally:
- Compassionate satisfaction
- Burnout
- Secondary traumatic stress
What did you learn from your colleagues?
 How are you going to apply this trauma
informed philosophy to educating students?
Questions?
 References

Cannon, L. M., Coolidge, E. M., LeGierse, J., Moskowitz, Y., Buckley, C., Chapin, E., Warren, M., & Kuzma, E. K. (2020). Trauma-informed
education: Creating and pilot testing a nursing curriculum on trauma-informed care. Nurse Education Today, 85, 104256.
https://doi.org/10.1016/j.nedt.2019.104256

Kimberg, L., & Wheeler, M. (2019). Trauma and trauma-informed care. Trauma-Informed Healthcare Approaches, 25-56. doi:10.1007/978-
3-030-04342-1_2

Levenson, J. S., Willis, G. M., & Prescott, D. S. (2016). Adverse Childhood Experiences in the Lives of Male Sex Offenders: Implications for
Trauma-Informed Care. Sexual Abuse, 28(4), 340-359. https://doi.org/10.1177/1079063214535819

LoGiudice, J. A., & Douglas, S. (2016). Incorporation of Sexual Violence in Nursing Curricula Using Trauma-Informed Care: A Case Study.
Journal of Nursing Education, 55(4), 215-219.
https://doi.org/http://dx.doi.org.library.capella.edu/10.3928/01484834-20160316-06

Racine, N., Killam, T., & Madigan, S. (2020). Trauma-Informed Care as a Universal Precaution: Beyond the Adverse Childhood Experiences
Questionnaire. JAMA Pediatrics, 174(1), 5-6. https://doi.org/10.1001/jamapediatrics.2019.3866

Williams, T. M., & Smith, G. P. (2017). Does training change practice? A survey of clinicians and managers one year after training in trauma-
informed care. The Journal of Mental Health Training, Education, and Practice, 12(3), 188-198.
http://dx.doi.org.library.capella.edu/10.1108/JMHTEP-02-2016-0016

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